Pharmacology of Mood stabilizers Flashcards
What are the antimanic drugs
Litihium salts (LiCO3 and LiCL), anticonvulsant drugs
What are adjunctive drugs used to control mania
Antipsychotic agents, benzodiazepines, calcium channel antagonists
What is the onset of action for lithium salts
Up to 3 weeks
T/F: Lithium is a good substrate for the Na/K pump
False: Lithium is NOT a good substrate for the Na/K pump
What are the propsed mechanisms of lithium action
Depleting 2n messesngers for ACh and NE trnsmission (PIP2, IP3, DAG), inhibits NE-adenylyl cyclase (lowering cAMP concentration), uncouples cGMP from G-proteint, disrupting neuronal transmission
How does effect neurotransmission when using antipsychotics
Blocks development of dopamine supersensitivity
When is the most important time to monitor lithium
Initiation of therapy
What are the target levels for acute mania, maintenance
0.9-1.2 mEq/L, 0.6-0.9 mEq/L
What the pharmokinetics of lithium
Readily abosrbed from the GI tract, reach peak in 2-4 hours
T/F: Unique to lithium, final volume of distribution accurately approximates volume of distribution of total body water
True
What is the side effect of fast rates of lithium increase, high lithium concentration
GI disturbance (nausea), polyuria (excess urination) and polydipsia (excess thirst)
What causes the polyuria and polydipsia seen in high lithium concentrations
Uncopules G-protein from the vasopressin receptors, preventing the renal collecting ducts from conserving water even then in the presence of ADH
T/F: Lithium causes hypothyroidism and is teratogenic
True
What is kindling, how does this relate to mania
Repeated neuronal firing recruits neighboring neurons to fire in unison causing hypersensitivity to firing, less kindling leads to less recurrent episodes
What are the anticonvulsants that are used for mania
Valporic acid, divalproex, carbamazepine, lamotrigine
How does VPA work for mania treatment
Suppress glutamate activity and increases GABA activity
What is divalproex, advantage, approved for
1:1 molar concentration of valproate Na and valproic acid, nausea and vomiting less common than with VPA, acute mania
What is the MOA of carbameazpine for mania
Inhibits both sodium and potassium channels ENHANCing the inhibitiory action of GABA on high-frequency repetitive neuronal firing
T/F: Oxcarbazepine has the same MOA as carbamezapine as a mood stabilizer
False: Ocarbazepine has never be proven to be a mood stabilizer and only blocks voltage sensitive sodium channels
What is the MOA of lamotrigiine as a mood stabilizer
Inactivetes voltage-sensitive sodium channels reducing the release of glutamate
What are the L-type calcium channels used for mood stabilizing, how do they aid in mood stabilization
Nimodipine and verapamil, Block calcium channels, thereby enhancing the inhibitory action of GABA
What is the place of therapy for antipsychotics
Treat acute phase of manic episodes as adjunctive therapies
What are they atypical antipsychotics used for acute mania
Olanzapine, quetiapine, risperidone, aripiprazole
What are the typical psychotics used for acute mania
Chlopromazine, thioridazine
What are the BZDs used for adjunctive therapy for mania episodes
Clonazepam and Lorazepam
